A positive yet complicated case of gender-based violence coordination: a qualitative study of Lebanon's protracted humanitarian emergency, 2012-22.

Gender-based violence (GBV), a global health and human rights concern, often intensifies during emergencies. This paper explores the evolution of GBV coordination in Lebanon's protracted Syrian refugee crisis from 2012-22. Utilising 38 in-depth interviews and a document review, the findings were analysed using the framework for effective GBV coordination. Lebanon provides a positive yet complicated example of GBV coordination. Initially established to address the refugee crisis, it matured into a collaborative national coordination mechanism, fostering trust and advancing localisation amidst sectarian complexities. However, the volatile, restrictive policy context hindered government co-leadership and engagement with refugee-led organisations. While essential GBV response services were expanded nationwide, lack of an interagency strategy on GBV risk mitigation and prevention compromised lasting change. The paper emphasises the importance of dedicated GBV coordinators, multi-year funding, and increased attention to GBV prevention. The findings underscore the transformative potential of humanitarian responses and advocate for enhanced engagement with national stakeholders to promote sustainability in protracted crises.

A qualitative investigation of gender-based violence prevention and response using digital technologies in low resource settings and refugee populations.

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020-2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.

Digitalization occurs when products and services are converted to digital forms; violence prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries were no exception to the rapid trend of digitalization during the COVID-19 crisis.Using key informant interviews with service providers working in violence prevention and response sectors in Brazil, Guatemala, Iraq, and in Italy regarding forcibly displaced women/girls, we investigated the rapid digitalization of gender-based violence prevention/response during the COVID-19 crisis.The effectiveness, safety, and equitability of digitalized violence prevention/response services depends on how well they are balanced vis-a-vis the gender digital divide and risk of digital GBV.

Victims of drug facilitated sexual assault aged 13-24: a cross sectional study on the pool of users of a sexual violence relief centre in Northern Italy.

This cross-sectional study aimed to assess the association between drugs and alcohol intake and sexual abuse in adolescents, otherwise defined as Drug Facilitated Sexual Assault (DFSA). We considered the survivors who accessed care at the Centre "Soccorso Violenza Sessuale" (SVS - Sexual Violence Relief Centre) in Turin (Italy), between May 2003 and May 2022. We found that 973 patients aged 13-24 among which 228 were victims of DFSA. Epidemiological and anamnestic aspects of the episode of sexual violence were examined, with a specific focus on investigating the alcohol and/or drug intake as reported by the victim, along with the results of the toxicological analysis. the study further accounts for the variations caused by the COVID-19 pandemic on DFSA-related accesses. Our findings show that 23% of adolescents accessing care at SVS were subjected to DFSA. Six out ten adolescents knew their aggressor, at times a partner (10%) oran acquaintance (43%). In 12% of cases violence was perpetrated by a group of people (12%). Almost 90% of young victims described alcohol consumption, while 37% reported drug use at the time of the assault. Alcohol taken alone or in combination with other substances was the most detected drug in our sample throughout the period considered. Given the large use of psychoactive substances among adolescents, it is imperative to implement harm reduction strategies alongside educational activities aimed at fostering awareness about consent. Health personnel should be trained to manage the needs of victims of DFSA clinically and forensically.

Associations between child marriage and food insecurity in Zimbabwe: a participatory mixed methods study.

BACKGROUND: Child marriage is a global crisis underpinned by gender inequality and discrimination against girls. A small evidence base suggests that food insecurity crises can be both a driver and a consequence of child marriage. However, these linkages are still ambiguous. This paper aims to understand how food insecurity influences child marriage practices in Chiredzi, Zimbabwe. METHODS: Mixed methods, including participant-led storytelling via SenseMaker® and key informant interviews, were employed to examine the relationship between food insecurity and child marriage within a broader context of gender and socio-economic inequality. We explored the extent to which food insecurity elevates adolescent girls' risk of child marriage; and how food insecurity influences child marriage decision-making among caregivers and adolescents. Key patterns that were generated by SenseMaker participants' interpretations of their own stories were visually identified in the meta-data, and then further analyzed. Semi-structured guides were used to facilitate key informant interviews. Interviews were audio-recorded, and transcribed and translated to English, then imported into NVivo for coding and thematic analysis. RESULTS: A total of 1,668 community members participated in SenseMaker data collection, while 22 staff participated in interviews. Overall, we found that food insecurity was a primary concern among community members. Food insecurity was found to be among the contextual factors of deprivation that influenced parents' and adolescent girls' decision making around child marriage. Parents often forced their daughters into marriage to relieve the household economic burden. At the same time, adolescents are initiating their own marriages due to limited alternative survival opportunities and within the restraints imposed by food insecurity, poverty, abuse in the home, and parental migration. COVID-19 and climate hazards exacerbated food insecurity and child marriage, while education may act as a modifier that reduces girls' risk of marriage. CONCLUSIONS: Our exploration of the associations between food insecurity and child marriage suggest that child marriage programming in humanitarian settings should be community-led and gender transformative to address the gender inequality that underpins child marriage and address the needs and priorities of adolescent girls. Further, programming must be responsive to the diverse risks and realities that adolescents face to address the intersecting levels of deprivation and elevate the capacities of adolescent girls, their families, and communities to prevent child marriage in food insecure settings.

Global Indigenous gender concepts, gender-based violence and resilience: A scoping review.

BACKGROUND & OBJECTIVE: The legacy of colonialism includes ongoing trauma and disruption of traditional teachings on relationality, which has contributed to Indigenous populations being disproportionately exposed to gender-based violence (GBV). GBV in Indigenous populations is explored to consider gender-specific findings and points of resilience in relational networks. PARTICIPANTS & SETTING: Included articles sampled Indigenous groups in Canada, US, Mexico, Guatemala, and Israel. All participants self-identified as Indigenous, and were either GBV survivors or service providers working in GBV contexts. METHODS: A scoping review was conducted in OVID Medline, Embase, APA Psycinfo, and Informit Indigenous Collection, using keywords for Indigenous peoples, gender concepts, and GBV. Articles were screened and extracted by two reviewers; a third reviewer resolved conflicts. RESULTS: Our search yielded one mixed-method study and seven qualitative studies, all published since 2016. North American studies identified colonial, patriarchal disruptions (e.g. residential schools) to positive pre-contact gender norms (e.g. non-hierarchical roles) that contribute to emerging GBV. Studies conducted in Guatemala and Israel also described local patriarchal cultures contributing to GBV. Lack of understanding of the Two-Spirit identity (i.e. supra-binary gender identity used by Indigenous persons) led to harmful attitudes and stigma. Interpersonal support and return to traditional matriarchal practices were identified as key resilience processes. CONCLUSIONS: There is limited literature on Indigenous gender concepts and GBV, particularly regarding GBV against males and Two-Spirit persons. Colonization-related violence and/or patriarchal gender norms were identified as precursors for GBV. Decolonization processes should be further explored to address GBV in Indigenous populations.

Violence Against Women Who Sell Sex in Eastern and Southern Africa: A Scoping Review.

Women who sell sex (WSS) are vulnerable to violence. We present a scoping review of the last decade of research on the prevalence and incidence of, factors associated with, and services regarding violence against WSS in Eastern and Southern African (ESA). A systematic search of various databases resulted in 20 papers being reviewed. Inclusion criteria, applied by the first two authors, were as follows: empirical papers, key research problem is violence against WSS, and conducted in ESA countries. The lifetime prevalence of violence revealed in the studies ranged from 21% to 82%. A pattern of generalized violence against WSS from paying clients, male partners, strangers, family members, friends/acquaintances, and the authorities emerged. Factors associated with violence included the context within which the sex work occurs, alcohol use, type of sex exchange interactions, and personal factors (low education, low income, marriage, youth, high client volume, time in sex work, forced sexual debut, and internalized sex work stigma). WSS seldom access services after violence. Evaluations of two programs, a woman-focused HIV intervention, and the Diagonal Interventions to Fast-Forward Reproductive Health project, showed improvements in gender-based violence services. Findings suggest that targeted programmes should be paired with improving general health services and focus on promoting collective agency among WSS.

Applying the Social-Ecological Framework to Link the Drivers of Intimate Partner Violence Among Women in the Caribbean and Their Risk for HIV Infection.

For countries with a high prevalence of HIV such as in the Caribbean, intimate partner violence (IPV) may increase the chances for acquiring HIV infection. Using secondary data, we compared findings from studies conducted in five Caribbean countries measuring the prevalence of gender-based violence among women in Grenada, Jamaica, Guyana, Suriname, and Trinidad and Tobago. The Social-Ecological Framework was used to categorize women's dual risk for intimate partner violence and HIV. We found that younger age, lower education, childhood experiences of abuse, income dependency, controlling behaviors of partners, non-disclosure of violence, and early sexual experiences were associated with intimate partner violence. These factors also predispose women in the Caribbean to HIV infection. The Social-Ecological Framework is applicable to understanding the drivers of intimate partner violence and HIV infection at multiple levels and for the design and promotion of combined prevention interventions. Our study also demonstrated the applicability of the Social-Ecological Framework as an analytical and predictive model underscoring the need for increased coordination across multiple actors to strengthen advocacy, given the pervasiveness of harmful social norms and gender inequalities which undermine IPV and HIV control efforts.

Tírala Plena: findings from the formative research to inform the initiative "Reaching those most left behind through comprehensive sexuality education for out-of-school young people" in Colombia.

This paper presents the results of formative research conducted from January to June 2020 in the Department of Atlántico, Caribbean region of Colombia, whose findings were used as inputs to design the national strategy for comprehensive sexuality education (CSE) outside school - Tírala Plena - including its curriculum. This is within the framework of the multi-country project coordinated by UNFPA and WHO aimed at generating evidence on the role of facilitators in the delivery of CSE in non-school contexts. The research was carried out in four municipalities in northern Colombia, in rural and marginal urban contexts with conditions of vulnerability for the adolescent population, including a strong presence of migrant populations from Venezuela. A total of 150 male and female adolescents ages 10-17 participated in the formative research. Workshops such as patchwork quilt, body mapping and talking maps were used as methods to gather information. The groups were divided by sex and age (10-13 years old and 14-17 years old). Knowledge, attitudes and social norms regarding adolescent pregnancy, sexually transmitted infections, including human immunodeficiency virus, and gender-based violence, were identified in adolescents (schooled and not schooled, but with minimal or no access to CSE). All of the above enabled us to establish a set of recommendations for the strengthening of the CSE strategy Tírala plena.

Domestic violence against women in Jordan: analysis of the demographic and health survey dataset 2017-2018.

This study analyzed the 2017-2018 Jordan Demographic and Health Survey (DHS) database to determine the prevalence of domestic violence (DV) against women in Jordan and its associated sociodemographic factors. The findings revealed that among Jordanian women, the lifetime prevalence of DV by husbands was 25.9%, with emotional (20.6%), physical (17.5%), and sexual (5.1%) violence being prominently reported. DV against women was significantly associated with the age, region, and educational status of women, as well as the wealth index, but not their husbands. While the results suggest a potential reduction in DV estimates compared to the last decade, DV still represents a public health issue in Jordan. The study highlights the direct association of DV with socio-demographic characteristics and provides a gateway to identifying high-risk women and implementing appropriate interventions to reduce DV.

Victims or perpetrators, agency, and politics of intimate partner violence in the social construction of health and wellbeing: a qualitative study from Kenya.

Deeply rooted cultural beliefs and norms relating to the position and the responsibilities assigned to men and women play a significant role in propagating intimate partner violence (IPV). It is yet to be understood in what ways experiences of IPV contribute to how people socially construct their health and wellbeing as they navigate the tensions created by the prevailing sociocultural systems. To address this knowledge gap, we employed a social constructionist perspective and the eco-social model to explore how Kenyans aged 25-49 years socially construct their health and wellbeing in relation to their experiences of IPV. We conducted nine in-depth interviews and ten focus group discussions in four counties in Kenya between January and April of 2017. Textual analysis of the narratives reveals that although men are usually framed as perpetrators of violence, they may also be victims of reciprocal aggression by women, as recently witnessed in cases where women retaliate through gang attacks, chopping of male genitalia, and scalding with water. However, women are still disproportionately affected by gender-based violence because of the deeply rooted gender imbalances in patriarchal societies. Women experience social stigma associated with such violence and when separated or divorced in situations of unsafe relationships, they are viewed as social misfits. As such, most women opt to stay in unhealthy relationships to avoid social isolation. These experiences are not only unhealthy for their psychological wellbeing but also for their physical health and socioeconomic status and that of their offspring.

Gender based violence (GBV) coordination in a complex, multi-crisis context: a qualitative case study of Lebanon's compounded crises (2019-2023).

BACKGROUND: Since 2019 Lebanon has faced multiple compounded crises. Political and social instability, the COVID-19 pandemic, and the Beirut Port explosion, alongside the influx of refugees related to the ongoing Syrian conflict, have resulted in a nationwide economic emergency. In the context of the humanitarian response to the Syrian conflict, the UN and government-led gender-based violence (GBV) task force has coordinated the sub-sector since 2012. The compounded crisis, however, created new challenges for GBV coordination and service delivery, which we explore in this paper. We highlight lessons for strengthening GBV coordination in Lebanon and other complex emergencies. METHODS: We conducted 29 remote in-depth interviews, reviewed key policy documents and observed seven GBV task force meetings. We analysed and presented our findings across three key themes: context-relevant and adaptable coordination mechanisms; coordination to support GBV service delivery; and stakeholders' roles, legitimacy and power. RESULTS: Parallel response frameworks developed to address the multiple crises, created a complex humanitarian architecture within an increasingly challenging operating context, with some perceived inefficiencies. Positively, coordination was integrated under the established government-UN interagency system and the GBV task force maintained GBV sub-sector coordination. The task force was commended for effectively adapting to the evolving context, including working remotely, maintaining essential GBV services, assessing the compounded crises' impact on programming and adjusting accordingly, and harmonising guidance, tools and approaches. The importance of ensuring a government co-led response was highlighted by both UN and government informants, who pointed to examples where marginalising government leadership compromised coordination effectiveness and sustainability. The participation of local actors had become increasingly important but more difficult, with the impact of the various crises, and remote modalities, challenging service delivery and staff wellbeing. CONCLUSION: Experiences from Lebanon highlight the essential role of government leadership in coordination; the value of investing in local GBV capacity; the significance of effective national, subnational and intersectoral coordination to support service delivery and address cross-cutting GBV issues; the importance of targeted interventions to support marginalised populations; and the need to prioritize the well-being of front-line staff during crisis response. In Lebanon, and other complex crises, donors are encouraged to increase flexible, multiyear funding for GBV coordination and services, while women-led organizations should be at the forefront of recovery efforts, contributing to a more equitable society.

Prevalence and perceptions of gender-based violence, and factors associated with gender-based violence among adolescents in Addis Ababa, Ethiopia: A Cross-sectional study.

This study examined the prevalence and perception of Gender-Based Violence (GBV) and factors associated with GBV among in-school Ethiopian adolescents. This cross-sectional quantitative study was conducted in Addis Ababa with 1,014 male and female adolescents aged 15-19. We examined differences by sex using the two-sample test of proportions and used multiple regression models to identify factors associated with GBV. Male respondents reported higher acceptability of GBV, while the overall mean empowerment construct was higher among females. Older adolescents (AOR: 1.43, 95% CI: 1.21, 1.69) and females (AOR: 2.15, 95% CI: 1.46, 3.14) were significantly more likely to experience sexual violence, and males were more likely to experience physical violence (AOR: 3.71, 95% CI: 2.15, 6.39). The study emphasizes the need for urgent multisectoral engagement to prevent and respond to GBV among adolescents. Tailored, school-related interventions may be an important means to address, prevent, and refer survivors of GBV.

Cette étude a examiné la prévalence et la perception de la violence basée sur le genre (VBG) et les facteurs associés à la VBG parmi les adolescents éthiopiens scolarisés. Cette étude quantitative transversale a été menée à Addis-Abeba auprès de 1 014 adolescents, hommes et femmes, âgés de 15 à 19 ans. Nous avons examiné les différences selon le sexe à l'aide du test des proportions à deux échantillons et avons utilisé des modèles de régression multiple pour identifier les facteurs associés à la VBG. Les hommes interrogés ont signalé une plus grande acceptabilité de la VBG, tandis que le concept moyen global d'autonomisation était plus élevé chez les femmes. Les adolescents plus âgés (AOR : 1,43, IC à 95 % : 1,21, 1,69) et les femmes (AOR : 2,15, IC à 95 % : 1,46, 3,14) étaient significativement plus susceptibles d'être victimes de violence sexuelle, et les hommes étaient plus susceptibles d'être victimes de violence physique (AOR : 3,71, IC 95% : 2,15, 6,39). L'étude souligne la nécessité d'un engagement multisectoriel urgent pour prévenir et répondre à la VBG chez les adolescents. Des interventions adaptées et liées à l'école peuvent être un moyen important de traiter, de prévenir et d'orienter les survivants de VBG.

Negative consequences of conflict-related sexual violence on survivors: a systematic review of qualitative evidence.

BACKGROUND: Conflicts exacerbate dynamics of power and inequalities through violence normalization, which acts as a facilitator for conflict-related sexual violence. Literature addressing its negative outcomes on survivors is scant. The aim of this systematic review was to analyze the qualitative evidence reported in scientific literature and focusing on the negative consequences of conflict-related sexual violence on victims' physical, psychological, and social dimensions of health in a gender-inclusive and disaggregated form. METHODS: A literature search was conducted on January 13, 2023 on Pubmed, Scopus, and PsychArticles. The search strings combined two blocks of terms related to sexual violence and conflict. A time filter was applied, limiting the search to studies published in the last ten years. Information regarding the main characteristics and design of the study, survivors and their experience, and about conflict-related sexual violence was collected. The negative consequences of conflict-related sexual violence on the physical, psychological, and social dimension of victims were extracted according to the Biopsychosocial model of health. The review followed the Joanna Briggs Institute methodology for systematic reviews and relied on the Preferred Reporting Items for Systematic reviews and Meta-Analyses. RESULTS: After full text review, 23 articles met the inclusion criteria, with 18 of them reporting negative repercussions on physical health, all of them highlighting adverse psychological outcomes, and 21 disclosing unfavorable social consequences. The negative outcomes described in multiple studies were sexual and reproductive health issues, the most mentioned being pregnancy, manifestations of symptoms attributable to post-traumatic stress disorder, and stigma. A number of barriers to access to care were presented as emerging findings. CONCLUSIONS: This review provided an analysis of the negative consequences of conflict-related sexual violence on survivors, thus highlighting the importance of qualitative evidence in understanding these outcomes and addressing barriers to access to care. Conflict-related sexual violence is a sexual and reproductive health issue. Sexuality education is needed at individual, community, and provider level, challenging gender norms and roles and encompassing gender-based violence. Gender-inclusive protocols and services need to be implemented to address the specific needs of all victims. Governments should advocate for SRHRs and translate health policies into services targeting survivors of CRSV.

Evidence generation for sustained impact in the response to gender-based violence: lessons from the SRHR Africa Trust Zimbabwe.

Gender-based violence (GBV) is a pervasive problem in Zimbabwe, affecting women and girls. The types of GBV that are prevalent in Zimbabwe include sexual violence, intimate partner violence, and child marriage. The issue of evidence generation remains crucial in developing interventions that are tailor-made for GBV response. In an attempt to build pathways for the strengthening of GBV programming and to influence policy change, the Sexual and Reproductive Health and Rights (SRHR) Africa Trust (SAT) Zimbabwe conducted a secondary data review of GBV cases recorded in 2018 and 2019 in collaboration with the Zimbabwe Republic Police (Victim Friendly Unit) to understand the incidence of and the driving factors underlying GBV in Zimbabwe, including context-specific information with regard to sexual violence and an overview of perpetrator types. The study proffered recommendations that focus on the importance of improving GBV reporting and programming in Zimbabwe. The study establishes that the driving factors for physical violence include poverty, infidelity, and alcohol and drug abuse, while sexual violence is perpetrated by intimate partners and close relatives, among other driving factors.

Midwife-led pandemic telemedicine services for maternal health and gender-based violence screening in Bangladesh: an implementation research case study.

BACKGROUND: The COVID-19 pandemic disrupted maternal and newborn health services in Bangladesh, exacerbating the large gaps in service utilization that existed prior to the pandemic. As part of its response, Bangladesh initiated remote antenatal and postnatal care telemedicine services led by midwives in 36 sub-district hospitals across five of Bangladesh's 64 districts. Gender-based violence screening and referral were integrated into the service to address a reported rise in violence following the country's pandemic lockdown. METHODS: Mixed-methods implementation research was used to develop an intrinsic case study describing the design and implementation of the telemedicine program. Qualitative analysis comprised document review, key informant interviews, and focus group discussions. Quantitative analysis employed an interrupted time series analysis with segmented multi-variate regression to compare maternity care service use trends before and after implementation. Poisson regression analysis was used to examine the trend in number of gender-based violence remote screenings, sessions held, and cases identified. RESULTS: A statistically significant change in trend for onsite antenatal and postpartum care as well as women seeking care at the hospital as a result of postpartum hemorrhage arising in the community was observed following the introduction of telemedicine. Facility births and cases of eclampsia appropriately identified and managed also had significant increases. In addition, over 6917 women were screened for GBV, 223 received counseling and 34 referrals were made, showing a statistically significant increase in frequency over time following the implementation of the telemedicine program. Challenges included that not all midwives adopted GBV screening, some women were reluctant to discuss GBV, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. CONCLUSIONS: Maternal health and gender-based violence telemedicine led by midwives was an effective, low-cost intervention in Bangladesh for addressing pandemic and pre-pandemic gaps in service use. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider whether a patient visit scheduling system needs to be introduced, as well as limitations around mobile phone access and connectivity. Future research should include care quality oversight and improvement, and a more well-informed strategy for facilitating effective GBV screening.

To support the continuation of sexual and reproductive health services following pandemic lockdowns, Bangladesh introduced a midwife-led telemedicine program. Through the program, midwives who were already employed within the health system delivered remote antenatal and postnatal care, including gender-based violence screening and referral. The program operated in 36 sub-district hospitals across five of Bangladesh's 64 districts. Intrinsic implementation research was used to develop a case study describing the design and implementation of the telemedicine program. Qualitative and quantitative methods comprised document review, key informant interviews, focus group discussions, and service use trends. Analysis of the data identified a statistically significant trend increase for most maternity care services. Although they did increase significantly over time, referrals for GBV were less than expected, which may have been related to some midwives not screening for GBV, and/or that many women were reluctant to discuss GBV. In addition, there was an unanticipated need to introduce a patient visit scheduling system in all intervention hospitals, and many women were not reachable by phone due to lack of access or network coverage. In spite of this, 6197 women were screened for GBV. Of those, 223 received counseling and 34 received referrals. Overall, telemedicine led by midwives was an effective, low-cost intervention for maternal health, and a step toward stronger GBV response in Bangladesh. Other low and middle-income countries planning to implement remote maternal health interventions via midwives should consider what is needed to facilitate comfort for both providers and women as related to GBV screening, as well as practical issues regarding introducing scheduling systems and limitations of mobile phone access and connectivity.

"Going Forward Like a Grandmother in the Snow": Personal Survival Strategies, Motherhood, and Nature as Resources for Mothers Who Have Experienced Intimate Partner Violence.

After suffering interpersonal violence (IPV), women survivors can access various interdisciplinary services and programmes to guide their recovery. Nevertheless, many vulnerable women postpone seeking help, sometimes indefinitely. Motherhood especially complicates help-seeking because mothers often want to protect both the perpetrator and their children. Understanding women's resilience, resources, and capacities in surviving IPV, however, could guide the development of helpful services that women actually access. Thus, in our study, we sought to explore the agency, resources, and reinforcing survival experiences of survivors of IPV. Our data, gathered in Finland during the COVID-19 pandemic, consisted of 12 narratives of mothers told in Clinical Ethnographic Narrative Interviews that were subsequently subjected to thematic analysis. Five themes describing personal resources, motherhood, and nature were identified under the overarching metaphor of "going forward like a grandmother in the snow". Recognising the agency, resources, capacities, and coping mechanisms of women who have suffered IPV can help in developing professional outreach programmes, promoting women's early access to useful resources, and, in turn, helping them to stop the possible intergenerational transmission of violence.

Depression, Alcohol Misuse, and Suicide Attempt Among North Korean Refugee Women Exposed to Gender-Based Violence.

North Korean (NK) refugee women report a disproportionately high rate of suicide compared to the general South Korean (SK) population. NK refugee women's exposure to gender-based violence (GBV) is a risk factor for adverse mental health symptoms. However, the association between GBV exposure and mental health has received less scholarly attention. This study examined NK refugee women's exposure to GBV (i.e., sexual violence, human trafficking, and forced sex work) and explored whether it is associated with an increased risk of depression, alcohol misuse, and suicide attempts. A three-way interaction between depression, alcohol misuse, and suicide attempts among GBV-exposed NK refugee women was examined. Data from a snowball sample of 180NK refugee women were analyzed for this study. Findings show that 47.8% experienced GBV in either NK or intermediary countries. Multivariate analyses revealed that depression (OR = 1.13, p < .05) and alcohol misuse (OR = 3.01, p < .01) was significantly associated with suicide attempts in GBV-exposed groups. Results from the three-way interaction (GBV victimization × Depression × Alcohol misuse) suggest that GBV exposure and higher levels of depression were significantly associated with suicide attempts among NK refugee women with greater severity of alcohol misuse (OR = 1.75, p < .05). The findings indicate that NK refugee women with GBV exposure, depression, and alcohol misuse are at increased risk for suicide attempts. Study limitations included the use of snowball sampling and cross-sectional data. This study discusses implications for future research and targeted, trauma-informed treatments focused on GBV and mental health symptoms among NK refugee women.

Government responses to COVID-19 and impact on GBV services and programmes: comparative analysis of the situation in South Africa, Kenya, Uganda, and Nigeria.

As governments impose restrictive policies to contain infectious disease outbreaks, pre-existing gender-based inequalities are often exacerbated, increasing the risk of gender-based violence (GBV). Despite international guidance on the need for continued provision of GBV services during emergencies, governments often de-prioritise GBV services and programmes. We conducted a rapid assessment in South Africa, Kenya, Uganda, and Nigeria to examine the impact of COVID-19 policies on the availability of GBV prevention and response services. The study team interviewed 80 stakeholders representing different GBV services in the four countries. The interviews revealed strikingly similar government mis-steps that disrupted the availability of comprehensive GBV services. In all four countries, the government's failure to exempt the provision of multi-sectoral GBV services from initial lockdown restrictions led to confusion and disrupted the provision of critical GBV services such as clinical management of rape, legal and judicial services, psychosocial services, availability of shelters, and community-based prevention activities. The government's imposition of curfews, stay-at-home orders, and transportation restrictions further diminished access to services. Governments must strengthen currently available GBV prevention and response services and be better prepared for future pandemics. Following international guidelines, governments should deem GBV services as essential from the beginning with clear implementation plans. Governments must invest in community-based solutions and the expansion of digital tools to ensure everyone, especially those likely to be structurally excluded, have access to critical services during an emergency.

Access to information on gender-based violence prevention during COVID-19 lockdown in Uganda: a cross-sectional study.

Background: During the lockdowns to contain the COVID-19 pandemic in Uganda, women and girls, disproportionately, had increased exposure to gender-based violence (GBV). Access to high-quality and empowering information or knowledge to minimise the incidences of GBV for women, girls, men and boys, was, therefore, crucial. The purpose of this study was to understand the characteristics of the individuals who were unable to access such information, and if received information, was associated with more awareness in the populace. Methods: The data analysed were from a cross-sectional nationally representative phone survey of individuals aged 18 years and above from all four regions of Uganda. The survey was carried out by Uganda Bureau of Statistics using a purely quantitative approach, and all questions were closed-ended. The sample was stratified by sex, age, and geographical region, and executed in November 2020, six months after COVID-19 lockdown restrictions. Binary logistic regression analysis was used for data analysis in STATA software. Findings: Female respondents with tertiary education (OR = 0.47; 95% CI = 0.26, 0.85) and male respondents with tertiary education (OR = 0.70; 95% CI: 0.49, 1.00) were more likely to receive information on GBV prevention. Both female (aOR = 0.68; 95% CI: 0.52, 0.88) and male (aOR = 0.66; 95% CI: 0.50, 0.87) respondents who were working had about a third the odds of being unable to access information about GBV prevention. Female respondents living in urban areas were associated with less odds of being unable to access the information (aOR = 0.77; 95% CI: 0.59, 1.00), while unmarried male respondents had higher odds of being unable to access the information (aOR = 1.37; 95% CI: 1.00, 1.89). Respondents who reported being vulnerable to GBV were also more likely to know someone who experienced GBV. This was similar for female respondents (PR = 3.00; 95% CI: 2.26, 3.98) and male respondents (PR = 3.01, 95% CI: 2.3, 3.95) (PR = 5.49; 95% CI = 4.12-7.30). Results also indicated that both male (PR = 1.28; 95% CI: 1.14, 1.43) and female respondents (PR = 1.24; 95% CI: 1.11, 1.37) who did not perceive themselves at risk of GBV were less likely to know a GBV survivor. Interpretation: The individuals who were unable to access information had characteristics associated with GBV perpetration or victimization. Monitoring the dissemination and quality of information empowers individuals and communities to develop local solutions to GBV prevention and protection. The design of GBV prevention messages and delivery channels needs to take into consideration the risk factors at the different levels of the socio-ecological model (individual, community, institutional, and society). Interventions aimed at increasing access to information on GBV prevention should consider the different socio-demographic as well as context-specific factors. Funding: There was no funding source for this study.

The Use and Effectiveness of the Whole School Approach in School-Based Interventions Addressing Gender-Based Violence in Sub-Saharan Africa: A Systematic Review.

Adolescents and young people in sub-Saharan Africa (SSA) experience high rates of gender-based violence (GBV). The whole school approach (WSA) is an established benchmark of effective school-based interventions to address this issue. We conducted a systematic review of peer-reviewed literature using PubMed/Medline, EMBASE, Scopus, Web of Science, Cochrane Library, Clinicaltrials.gov, and Google Scholar (1) to determine the characteristics, measured outcomes, and effectiveness of school-based GBV interventions and (2) to examine each papers' alignment with WSA and methodological quality. We developed a comprehensive intervention characteristics form for data extraction and analyzed the selected studies' quality using the modified Methodological Quality Rating Scale. To measure alignment with WSA implementation standards, we expanded the application of the WSA by creating the Whole School Approach Rating Scale (WSARS) for assessing school-based GBV interventions. Most interventions (n = 14/16) we reviewed effectively addressed at least one of the three outcomes of interest (i.e., sexual violence, physical violence, and GBV-related knowledge/attitudes). Over half (n = 9/16) of the studies were rated high on the WSARS. However, we observed no significant differences in effectiveness between studies rated high and those rated low on the WSARS. Our results indicate that school-based GBV interventions could be an effective and sustainable strategy for addressing GBV in and around schools.